Low-Dose CT Screening Reduces Lung Cancer Mortality by 55% in Non-Risk-Based Population
核心洞察
The LUNG-CARE Project demonstrated that low-dose CT screening reduced lung cancer-specific mortality by 55% compared to routine medical care in a non-risk-based population (HR, 0.45; 95% CI, 0.32-0.65; P <.001).
Female patients showed particularly pronounced benefits with a 72% reduction in mortality risk (HR, 0.28; 95% CI, 0.13-0.60; P <.001), while males experienced a 45% reduction.
Patients with screen-detected cancers achieved significantly better 5-year overall survival rates of 87% compared to 39% in those without screen-detected disease.
Low-dose CT screening significantly reduced lung cancer-specific mortality in a non-risk-based population, according to groundbreaking findings from the LUNG-CARE Project presented at the 2026 European Lung Cancer Congress. The prospective interventional cohort study demonstrated a 55% reduction in mortality compared with routine medical care across the overall study population (HR, 0.45; 95% CI, 0.32-0.65; P <.001).
Gender-Specific Benefits Emerge
The screening benefits showed notable gender differences, with female patients experiencing a particularly pronounced 72% reduction in mortality risk (HR, 0.28; 95% CI, 0.13-0.60; P <.001). Male patients also benefited significantly, though to a lesser extent, with a 45% reduction in mortality risk (HR, 0.55; 95% CI, 0.36-0.83; P = .004).
Superior Survival Outcomes for Screen-Detected Cases
Patients with screen-detected cancers demonstrated substantially better overall survival outcomes. The 5-year overall survival rate reached 87% for those with screen-detected disease compared to just 39% in patients without screen-detected disease (HR, 0.13; 95% CI, 0.09-0.19; P <.001). This dramatic difference underscores the clinical value of early detection through systematic screening.
Study Design and Population
The LUNG-CARE Project enrolled patients aged 40 to 74 years from the same geographic region between December 2015 and July 2021. Investigators assigned 11,708 individuals to undergo one-time low-dose CT screening, while 114,392 received routine medical care without systematic screening. The study identified 227 patients with lung cancer in the screening group compared with 1,105 in the non-screening group.
At baseline, both groups showed similar demographics, with most patients being female (53.5% vs 53.4% in non-screening vs screening groups) and having no history of tobacco use (80.7% vs 69.2%). However, disease stage distribution differed markedly between groups. Most patients in the non-screening group presented with stage IV disease (51.7%), while most in the screening group had stage I disease (81.5%). Adenocarcinoma represented the predominant histology in both groups (72.3% vs 93.4%).
Detection Rates Comparable to High-Risk Studies
Despite targeting a more general population, the LUNG-CARE Project achieved detection rates comparable to established high-risk screening studies. The baseline lung cancer detection rate was 1.9% for in situ and minimally invasive disease only, and 1.4% when accounting for invasive adenocarcinoma only. These rates matched those from other high-risk screening studies, including the TALENT and NLST studies.
Risk Stratification Insights
The study revealed important insights about risk stratification in lung cancer screening. Based on NCCN and Chinese risk definitions, significantly worse survival outcomes were observed among high-risk populations (P <.001). Respiratory comorbidities and heavy smoking emerged as adverse prognostic drivers for survival (P <.001). Notably, "non-high-risk" patients showed better survival and greater curative potential through early detection compared with traditionally defined "high-risk" individuals.
Clinical Implications and Future Directions
"The LUNG-CARE Project represents the first prospective non-risk-based lung cancer screening program and was associated with lower lung cancer-specific mortality than that observed in a contemporaneous non-screened population from the same region," stated study investigator Caichen Li, MD, from the First Affiliated Hospital of Guangzhou Medical University.
Li emphasized that compared with traditionally defined "high-risk" individuals, "non-high-risk" patients showed better survival and greater curative potential through early detection. However, he noted that "evaluation of screening strategies beyond conventional risk-based criteria highlight the need for randomized trials in non-high-risk populations before broader implementation is considered."
Study Limitations
The investigators acknowledged several limitations, including the non-randomized comparison design with potential residual confounding. Additional limitations included baseline and disease characteristic imbalances between screened and non-screened cohorts, susceptibility to lead-time bias and overdiagnosis in post-diagnosis survival analyses, and limited external generalizability based on the single-region and one-time screening design.